Matériel et méthodes
CONCLUSION GENERALE
L’incontinence par hyperactivité détrusorienne est l’un des troubles principaux caractéristiques du dysfonctionnement vésico-sphinctérien. Elle est due à une contraction involontaire du détrusor, constatation urodynamique caractérisée par des contractions détrusoriennes involontaires pendant la phase de remplissage.
L’urologue doit aujourd’hui impérativement proposer une prise en charge de ces troubles qui tiennent compte de la morbidité urinaire, mais aussi de l’amélioration de la qualité de vie des patients. Il s’agit de protéger le haut appareil urinaire, de prévenir l’infection génitale et urinaire et de permettre aux patients de retrouver une continence et une autonomie.
Parmi les différentes stratégies thérapeutiques développées, les injections de toxine botulique de type A dans le détrusor semblent pouvoir répondre positivement à cet impératif d’efficacité clinique de contrôle de l’hyperactivité vésicale, de prévention des risques et d’amélioration de la qualité de vie des patients. Elles trouvent ainsi une place significative au sein de l’échelle des décisions thérapeutiques.
Résumé
Cette étude prospective non randomisée avait pour objectif d’évaluer l’efficacité à moyen terme des injections de toxine botulique A dans le détrusor, chez les patients ayant une incontinence d’urine par hyperactivité vésicale. Les troubles urinaires sont, chez ces patients, une cause majeure de morbidité et également une cause sérieuse d’altération de la qualité de vie. Il s’agissait d’apprécier la technique par rapport à trois axes : le contrôle de l’hyperactivité vésicale, la prévention des dégradations de l’appareil urinaire et l’amélioration de la qualité de vie. Alors qu’aucun des patients n’était continent avant l’injection, 100% le devinrent à un mois et 66.7% l’étaient encore à six mois. L’efficacité de la technique est aussi perceptible sur les scores de Qualité de Vie. Nos résultats confirment ceux de la littérature : les patients sont traités avec succès. La toxine botulique intra-détrusorienne est un traitement efficace de l’hyperactivité vésicale, sa place comme modalité thérapeutique de l’hyperactivité détrusorienne est confirmée.
Abstract
This prospective non-randomized study was to evaluate the effectiveness of the medium-term injections of the botulinum toxin A into the detrusor, to patients with incontinence of urine by overactive bladder. Urinary disorders are, among these patients, a major cause of morbidity and also a serious cause of impairment of quality of life. This study was to assess the technique in relation to three axes: control of overactive bladder, preventing degradation of the urinary tract and improving the quality of life. While none of the patients were continent before injection, 100% were so within one month and 66.7% were still continent after six months. The effectiveness of the technique is also evident on scores of Quality of Life. Our results confirm those of literature: patients are treated successfully. The intra-detrusor botulinum toxin injection is an effective treatment of the overactive bladder, its place as a treatment modality for detrusor over-activity is confirmed.
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